Many patients who are diagnosed with bronchial asthma for the first time believe that now their life will change significantly, they will be deprived of many familiar joys, sports or certain types of activity (singing, dancing, professional activities). This is due to ignorance of the essence of the changes occurring in the respiratory system. It is important that patients understand why inflammation occurs, which makes breathing more difficult, edema of bronchial mucous membranes develops, and shortness of breath is formed. Understanding the essence of the process facilitates disease control.
Bronchial asthma – what is it?
Statistical data on the prevalence of asthma vary significantly from 2-3 to 10%, and these figures are growing annually. In some patients, the symptoms are variable and not very pronounced, and therefore the diagnosis is not exposed for a long time.
By definition, bronchial asthma is a chronic inflammatory process that affects the respiratory system. It is localized mainly in the area of the bronchi, inflammation is formed due to various cellular elements, which eventually leads to obstruction of the bronchi. The term “obstruction” refers to a sharp narrowing of the lumen through which air passes into the lungs.
Inflammation of the bronchi and its manifestations
The main manifestations typical of bronchial asthma are recurring bouts of difficulty breathing with wheezing, the development of shortness of breath, a feeling of tightness in the chest. Cough and change in the rheological properties of sputum (it is glassy, viscous) is also typical. The lumen of the bronchi narrows, but it can be returned to its original state, either fully or partially, the obstruction takes place on its own or under the influence of the drugs taken.
For physicians, the changes that occur during bronchial asthma are understandable, but the definition itself seems difficult for patients. They are afraid of the presence of inflammation in the bronchus, which does not pass. It is important to understand the essence of the changes, then the patient will understand how to deal with the disease.
Respiratory system and the act of breathing
To understand the essence of change, you need to know how to implement breath fine. The lower airways include the bronchi and lungs. The main bronchus, extending from the trachea, is divided into two, going to the left and right lung . Each of them is then successively divided into smaller and smaller “branches”, and the alveoli are located at the ends of the smallest, which are called bronchioles. It is in them that gas exchange occurs during breathing. For ease of understanding, the bronchi are compared with a tree: their structure as branches is similar, and the leaf analogues are alveoli. In the genesis of asthma, the structure of the bronchi is important, if you “cut” them across. Each bronchus looks like a three-layer ring, each of the layers is responsible for certain functions. The outer one creates a skeleton and protects it from neighboring tissues, the middle one is a layer of muscles. When they contract, the lumen of the bronchus narrows, if they are relaxed, it takes on its usual form. The inner layer is the mucous membrane of the bronchi, it is abundantly intertwined with blood vessels, it consists of several variants of cells necessary for full breathing to take place.
Thus, mucus is produced by the goblet cells, lubricating the bronchi from the inside, protecting them. These cells are in the area of large bronchi. There are also ciliary cells that have outgrowths at the upper pole. They make oscillatory movements, moving the mucus in the direction of the oropharynx. Due to them, the bronchi are cleaned from dust, viruses, microbes that enter them during breathing.
Features of an attack: where does dyspnea come from?
In bronchial asthma, attacks are typical for which breathing is difficult, shortness of breath, wheezing, and cough with thick sputum develop. This occurs under the influence of various factors, external or internal, which disturb the coordinated work of the respiratory tract. First of all, there is a strong muscle spasm in the bronchi, because of which their lumen sharply narrows. In parallel with this, an excess of mucus begins to be synthesized in the goblet cells, and it differs significantly in viscosity from the usual: viscous, very thick. Due to their activity, ciliated cells cannot move lumps of thick mucus in the bronchi. This forms shortness of breath, shortness of breath develops, as the air must be pushed through the narrowed bronchi with effort. Lumps of sputum impede the movement of air even more, causing wheezing.
Where does swelling in the bronchi come from?
If a bronchial asthma has an allergic origin (it is called atopic), when the allergen on the body instantly activates the immune system, which is responsible for the development of allergies. The cells of the immune system, previously sensitized with an allergen (trained to respond to it), begin to produce substances entering the blood and brought to the region of the mucous bronchi. Due to the activity of immune cells involved in the development of allergies, and swelling occurs. The mediators that have been synthesized by them, lead to an increase in the release of fluid from the capillaries, the mucous is impregnated with it, its edema is formed, which narrows the lumen of the bronchi. Considering also a spasm of muscular elements in the bronchus area, the presence of lumps of thick sputum, the lumen of some bronchi can close almost completely, which makes dyspnea worse, suffocation, and noisy breathing with whistles. In the presence of bronchial edema, respiratory disorders are sharply intensified.
In order to facilitate the breathing process in such conditions, patients reflexively lean their hands on objects (the back of a chair or bed, the surface of a table) in order to activate the auxiliary respiratory muscles and strengthen breathing. The constant presence of cells responsible for inflammation or allergies in the walls of the bronchi leads to a chronic process. Gradually, the structure of the bronchi changes, the muscular elements relax worse and worse, without any external influences. To help the patient in this situation, you need drugs that inhibit inflammation, and during attacks – also relieve bronchospasm, which facilitates the passage of air flow.